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Researching Aquatic Therapy's Effectiveness
©1997-2007, Aquaticnet.com
Aquaticnet.com wants to assist Team Aquatic Therapy members interested in performing research on the effectiveness of aquatic therapy. Ask yourself the questions below to determine what type of assistance you need.
Step 1: Determine what type of research you wish to perform.
| Experimental |
In an experimental study, you will place subjects in experimental conditions or interventions by random assignment. You will actively manipulate an independent variable (typically, your aquatic intervention) and you will attempt to hold all other variables constant. You will need at least two groups of subjects: one to serve as the experimental group and one to serve as a control. Randomized, controlled trials are the gold standard by which we examine therapeutic effects. |
| Non-experimental |
All studies which do not meet the above criteria. For example, Correlational Studies, Descriptive Studies, Historical/ Retrospective Studies, Quasi Experimental Studies, and Single Case Experimental Design. |
Step 2: Determine what type of research question you wish to ask.
How effective is a "reasonable and customary" bout (e.g. six weeks, ten weeks) of a given aquatic intervention for the treatment of a given impairment, functional limitation or disability compared to another 1:1 aquatic intervention? compared to group class aquatic intervention? compared to a given land-based intervention? compared to no intervention at all?
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What effect does one session of a given aquatic intervention (e.g. resistance training, prolonged stretch, aerobic exercise) have on the body's systems (e.g. musculoskeletal, neurological, cardiopulmonary, integumentary) compared to another aquatic intervention? compared to the same task performed at a different level of immersion? compared to the same task performed on land? compared to a similar task performed on land?
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What effect does a "reasonable and customary" bout (e.g. six weeks, ten weeks) of a given aquatic intervention (e.g. resistance training, prolonged stretch, aerobic exercise) have on the body's systems (e.g. musculoskeletal, neurological, cardiopulmonary, integumentary) compared to another aquatic intervention? compared to the same task performed at a different level of immersion? compared to the same task performed on land? compared to a similar task performed on land?
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What elements of immersed exercise are responsible for altering the status of a given impairment, functional limitation or disability? immersion alone, socialization alone, exercise alone, a combination of these elements?
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What effect does the use of a given piece of aquatic equipment (e.g. a cervical flotation collar, a resistance glove, a kickboard) have on the body's systems (e.g. musculoskeletal, neurological, cardiopulmonary, integumentary) compared to another piece of aquatic equipment? compared to the same piece of aquatic equipment used in a different manner (e.g. positioned or oriented differently, or moved at a higher velocity)? compared to the same piece of aquatic equipment used on land? compared to a different piece of equipment which was designed for a similar purpose when used on land?
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How does the cost (to the patient, to the clinic, to society) of a "reasonable and customary" bout (e.g. six weeks, ten weeks) of a given aquatic intervention compare to another 1:1 aquatic intervention? compare to group class aquatic intervention? compare to a given land-based intervention? compare to no intervention at all?
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What aquatic therapy knowledge and technical skills are being taught in entry-level professional programs in different disciplines?
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What characteristics differentiate the master from the novice aquatic therapy clinician?
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Step 3: Determine what type of outside assistance you will need.
1.Do you need help applying for a research grant?
Read the following article:
Eaves GN. Preparation of the research-grant application: opportunities and pitfalls. Grants Magazine. 1984; 7(3): 151-157
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Seek assistance. If you intend to seek financial assistance, you will need a grant application or business plan which is lucid, functional, and, most importantly, plausible. Although it is tempting to try to create such a document internally, it is rarely worthwhile to do so. Contact the Aquatic Resources Network to hire our grant proposal consultant, Andrea Poteat Salzman, MS, PT, or to find an alternative resource.
2. Do you need help formulating your research question?
Read the following research studies and find a question similar to that which you wish to ask. Remember, the patient population and intervention don't have to be identical to yours to help you design your question; the researchers just have to be asking a similar type of research question (see steps 1 and 2 above).
Note: by permission, these references have been excerpted from the Aquatic Therapy Research Bibliography, a 80+ page annotated bibliography published by the Aquatic Resources Network. To obtain the bibliography in its entirety, shop online.
Ahern M, Nicholls E, Simionato E, Clark M, Bond M. Clinical and psychological effects of hydrotherapy in rheumatic diseases. Clin Rehabil. 1995; 9(3): 204-212.
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Cochrane Library. Rheumatoid arthritis (RA) and osteoarthritis (OA): balneotherapy for patients with arthritis. The Cochrane Library (Oxford). 1998, issue 3. (on-line library).
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Kuhn G, Buhring M. Physical therapy and quality of life: design and results of a study on hydrotherapy. Complementary Therapies in Med. 1995; 3(3): 138-141.
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Kurabayashi H, Kubota K, Machida I, Tamura K, Take H, Shirakura T. Effective physical therapy for chronic obstructive pulmonary disease: pilot study of exercise in hot spring water. Amer J Phys Med Rehabil. 1997; 76(3): 204-207.
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Lord S, Mitchell D, Williams P. Effect of water exercise on balance and related factors in older people. Australian Journal of Physiotherapy. 1993; 39(3):217-222.
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McIlveen B, Robertson VJ. A randomised controlled study of the outcome of hydrotherapy for subjects with low back or back and leg pain. Physiotherapy. 1998; 84(1): 17-26.
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Simmons V, Hansen PD. Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. J Gerontology. 1996; 51A(5): M233-M238.
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Smith SS, MacKay-Lyons M, Nunes-Clement S. Therapeutic benefit of aquaerobics for individuals with rheumatoid arthritis. Physiotherapy Canada. 1998; 50(1): 40-46.
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Suomi R. Lindauer S. Effectiveness of Arthritis Foundation Aquatic Program on strength and range of motion in women with arthritis. J Aging Phys Activity. 1997; 5(4): 341-351.
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Takeshima N, Nakata M, Kobayashi F, Tanaka K, Pollock ML. Oxygen uptake and heart rate differences between walking on land and in water in the elderly. J Aging Phys Activity. 1997; 5(2): 126-134.
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Tovin BJ, Wolf SL, Greenfield BH, Crouse J, Woodfin BA. Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Phys Ther. 1994; 74(8): 710-719.
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| Verhagen AP, de Vet HCW, de Bie RA, Kessels AGH, Boers M, Knipschild PG, Sjogren T, Long N, Storay I, Smith J. Group hydrotherapy versus group land-based treatment for chronic low back pain. Physiotherapy Research International. 1997; 2(4): 212-222. |
3. Do you need help finding an aquatic facility in which to perform your data collection?
Contact the Aquatic Resources Network to search the Aquatic Therapy Database.
4. Do you need help designing your research methodology?
Unless you are an experienced researcher, you should never attempt to create a research methodology out of thin air. In research, plagarism (with citation) rules. Find a research study which has a solid methodology and copy it. For starters, take a look at the Simmons and Hansen article cited above. Never, never use an unvalidated instrument (such as a balance test created by you) in your research.
For your research to have any merit, you must use performance tools or quality of life indices which have been shown to be reliable and valid for certain populations. To examine some of these functional tools, read:
| Lewis CB, McNerney T (eds). The Functional Toolbox, Vols 1, 2. McLean, VA: Learn Publications; 1997, 1999. |
To order, call Learn Publications at (800) 762-0991.
5. Do you need help finding published literature on aquatic therapy?
If you have access to a medical library, you need the Aquatic Therapy Research Bibliography. Why spend hundreds of hours in front of Medline and other library indices tracking down articles on aquatic therapy? The Aquatic Resources Network has done the work for you. To order the bibliography, contact the Aquatic Resources Network by phone (715) 248-7258 or fax (715) 248-3065 or order online.
If you don't have access to a medical library, you are going to have a terrible time doing your literature review. However, the Prove It! handbook will help. To order the handbook, contact the Aquatic Resources Network or order online.
Finally, to find randomized, controlled clinical trials on all kinds of medical and therapy topics which might relate to your question, check out the following websites. (Don't forget to bookmark our site before you surf away!)
7. Do you wish to seek review and publication of your finished project?
Call the Aquatic Physical Therapy Section of the American Physical Therapy Association at (334) 990-5713 to find out how to submit your work for peer review to the Journal of Aquatic PT.
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